An Ontario court challenge revolving around mandatory referrals could spell big new for patients wanting to access medical cannabis as part of their treatment regimens. Whether or not that big news ultimately proves positive or negative for patients, however, will likely take some time to unfold.

After the recent Lift & Co. Cannabis Expo in Vancouver, I visited my parents in Abbotsford, a community about an hour’s drive away. Having grown up in a very religious household, my cannabis use has been a point of contention within the family. After three years, my parents are just now starting to get used to the idea that my daily medical cannabis use is here to stay.

So, I was more than a bit surprised after asking my father to join me while I went to the dispensary. I purchased some flower and explained to him how to consume concentrates on a dab rig. Though he still refuses to try CBD for his bad knee, even the hint of him wanting to learn about cannabis was encouraging, indeed.

Some physicians uncomfortable prescribing cannabis

In essence, the college found if physicians have a moral or religious objection to providing services, they must make a meaningful referral to a medical practitioner.

Just as my father’s faith plays a role in his guarded openness to cannabis, there are physicians across the country who may also not feel comfortable prescribing cannabis to patients for religious reasons. On Jan. 21, 2019, the Court of Appeal for Ontario heard arguments on that very question. On reviewing the case, it seems the central issue is whether or not physicians and surgeons who have religious objections to certain medical procedures can send their patients away without care, rather than referring them in good faith to a physician who is willing and able to do the task.

The initial ruling by the Divisional Court of Ontario’s Superior Court of Justice, in response to a challenge under the Canadian Charter of Rights and Freedoms by a collection of religious physicians’ associations, made clear that the policies stand. In essence, the college found that if physicians have a moral or religious objection to the provision of services, they must make a meaningful and effective referral to a medical practitioner who can provide the requested medical services.

While issues most often arise when dealing with abortion and/or medical aid in dying, medical cannabis patients have been affected. Some versions of Christianity do not consider cannabis to be medicine, suggesting that “physicians need to actively confront the view held by so many that marijuana is a safe, natural and weak hallucinogenic,” notes an article on the website of the Christian Medical & Dental Associations.

Anecdotally, would-be patients frequently report having been given the run-around by medical professionals, including a friend who told me her doctor refused to write a medical document for cannabis on religious grounds, insisting she opt for invasive nerve blockers, which ultimately didn’t work. Only after someone recommended a third-party clinic was she able to obtain a medical document for cannabis use.

Treating physician not the only option

At cannabis clinics, by and large, physicians are able to bill provincial health care plans for the appointment itself.

Many patients don’t realize they can pursue their medical cannabis documentation through a third-party clinic. While some of these clinics have recently been in the news for their financial ties to licensed producers, with a bit of research, patients can find independent clinics in their own communities that can provide access to medical cannabis.

In some cases, clinics may charge a nominal fee that provides open access to clinic educators whenever a patient has a question or concern about their medications. By and large, physicians are able to bill provincial health care plans for the appointment itself, just as any other doctor’s visit would be.

Many physicians who refuse to write a medical document for cannabis use do so not for moral or religious reasons, but simply because they do not know enough about medical cannabis to make an informed recommendation. The endocannabinoid system is not yet taught with regularity as a part of medical school curriculums, leading to a basic lack of knowledge, especially among doctors who have been practising for a long time.

When faced with the option to write a document for cannabis, which they know very little about, or to prescribe a more traditional pharmaceutical solution, it seems that doctors will take the latter more often than not.

While it’s taken a few years and a lot of conversation, my own parents have moved from outright hostility to curious bystanders. Ultimately, the hope is that physicians across Canada will come around sooner rather than later, religious objections or not.